Carcinoma Recurrence, Surgery Delayed With Topical Cream

Treatment of the face and ears with a single course of topical fluorouracil, 5% cream is safe and effective for the 1-year prevention of cancer-related surgery among individuals with a history of keratinocyte carcinoma, according to a recent study.

Keratinocyte carcinoma, which includes cutaneous basal cell carcinoma and squamous cell carcinoma, is the most common cancer in the United States.
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During the Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial, the researchers evaluated 932 veterans with a history of at least 2 keratinocyte carcinomas within the last 5 years (median age 70 years). Participants were recruited from 12 Veterans Affairs medical centers from May 2009 to September 2011. Follow-up lasted until June 30, 2013.

Each participant was randomly assigned to treatment with either topical fluorouracil, 5% (n = 468) or vehicle control cream (n = 464) to the face and ears twice daily for 2 to 4 weeks. The researchers measured participants for outcomes including surgically treated keratinocyte, basal cell and squamous cell carcinoma risk on the face and ears within the first year after enrollment, as well as time to first surgically treated carcinoma.

Over 4 years, 299 of 932 participants had developed basal cell carcinoma (95 in year 1), and 108 had developed squamous cell carcinoma (25 in year 1). The researchers observed no difference across groups in time to first keratinocyte, basal cell, or squamous cell carcinoma. However, during the first year, only 5 participants treated with fluorouracil had developed a squamous cell carcinoma compared with 20 treated with vehicle control cream (1% vs 4%).

The researchers found that, ultimately, the 11% decrease in basal cell carcinoma risk during the first year was not statistically significant, and that it had not significantly impacted the risk of keratinocyte carcinoma either. However, they noted a decrease in keratinocyte carcinomas treated with Mohs surgery.

“A conventional course of fluorouracil to the face and ears substantially reduces surgery for squamous cell carcinoma for 1 year without significantly affecting the corresponding risk for basal cell carcinoma,” the researchers concluded.

—Christina Vogt

Reference:

Weinstock MA, Thwin SS, Seigel JA, et al; Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial (VAKCC) Group. Chemoprevention of basal and squamous cell carcinoma with a single course of fluorouracil, 5%, cream: a randomized clinical trial [Published online January 3, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.3631.